Chromebook Repair Request Form
Please fill out this form to report and describe the Chromebook damage.
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student First Name
*
Student Last Name
*
Student Grade
*
Please Select
5th
6th
7th
8th
Student Homeroom Teacher
*
Please describe the damage below. Please be as detailed as possible. How did the damage occur? What time/date did the damage occur?
*
Submit Request
Should be Empty: